Zare Zahra, Haqbin Arash, Kalavani Khalil, Shojaei Payam
Department of Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Management, Shiraz University, Shiraz, Iran.
Int J Prev Med. 2023 Apr 28;14:55. doi: 10.4103/ijpvm.ijpvm_114_22. eCollection 2023.
One of the most effective strategies to improve the access of community members to health services is to regionalize health services. The purpose of this study is to examine and prioritize measures that could help to counteract obstacles and problems in implementing the regionalization of healthcare in Iran.
The study relied on a mixed research method, including qualitative and quantitative phases. First, by conducting semi-structured interviews and analyzing them through qualitative content analysis, the obstacles and measures were identified. In the quantitative phase, the obstacles identified were weighted using the fuzzy best-worst method (FBWM), and the measures were then prioritized through the fuzzy TOPSIS (FTOPSIS) method.
The obstacles were categorized into four main dimensions: "infrastructural," "political," "human resources," and "managerial." Among the 15 obstacles identified, "absence of performance guarantees" was the most important obstacle, while "insufficient education" was the least important obstacle to the regionalization of healthcare services in Iran. Meanwhile, the following eight measures that could help to overcome the obstacles were extracted from the interviews: "conducting a needs assessment," "providing clinical guidelines," "employing specialized human resources," "reinforcing the referral system," and "preparing electronic health records," "enhancing education and information dissimilation," "building executive support," and "providing cost-effective equipment and technology." "Employing specialized human resources" was also the most effective measure to overcome the obstacles.
Iranian healthcare policy-makers can use the empirical findings of this investigation to accelerate the implementation of Iran's regionalization plan to improve the access of community members to healthcare services.
改善社区成员获得卫生服务机会的最有效策略之一是卫生服务区域化。本研究的目的是审视有助于克服伊朗医疗保健区域化实施过程中的障碍和问题的措施，并对这些措施进行优先排序。
本研究采用混合研究方法，包括定性和定量阶段。首先，通过进行半结构化访谈并通过定性内容分析对其进行分析，确定障碍和措施。在定量阶段，使用模糊最佳-最差方法（FBWM）对确定的障碍进行加权，然后通过模糊理想解排序法（FTOPSIS）对措施进行优先排序。
障碍分为四个主要维度：“基础设施”、“政治”、“人力资源”和“管理”。在确定的15个障碍中，“缺乏绩效保证”是最重要的障碍，而“教育不足”是伊朗医疗保健服务区域化最不重要的障碍。同时，从访谈中提取了以下八项有助于克服障碍的措施：“进行需求评估”、“提供临床指南”、“聘用专业人力资源”、“加强转诊系统”、“准备电子健康记录”、“加强教育和信息传播”、“建立行政支持”以及“提供具有成本效益的设备和技术”。“聘用专业人力资源”也是克服障碍最有效的措施。
伊朗医疗保健政策制定者可以利用本调查的实证结果，加快伊朗区域化计划的实施，以改善社区成员获得医疗保健服务的机会。
